American Medical Association takes on marijuana … fumbles then punts

The American Medical Association’s House of Delegates, the policy-making body for the physician organization, voted yesterday to remain opposed to marijuana legalization, while at the same time declared the war on drugs a failure.

From an AMA committee’s report to the delegates: “Federal drug polices over the last 40 years have not accomplished their objectives. Policies should move away from arrest and incarceration of drug users by addressing drug misuse, addiction, and overdose through a public health framework, expanding access to treatment and redirecting law enforcement resources to prevent serious and violent crime.”

The delegates also recommended that “state-based drug legalization” efforts, such as in Washington and Colorado, be studied. Until the results of those studies come in, the AMA should “reaffirm its opposition to drug legalization.”

The group also reaffirmed its position that marijuana be studied, and that its “status as a federal schedule I controlled substance be reviewed with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines, and alternate delivery methods.”

So what exactly did the AMA do?

Looking at the edited document provides some insight into exactly what the AMA was wrestling with. After all, why go through the rigors of a policy edit if you’re just going to say the same things?

First, the AMA changes from a “go get ’em” attitude to “maybe we should take a more nuanced approach to drug policy” stance.

Here’s what the related after-edited sentence looks like:

“Advising the federal government and the nation should: (1) acknowledge that federal efforts to address illicit drug use via supply reduction and enforcement have been ineffective (2) expand the availability and reduce the cost of treatment programs for substance use disorders, including addiction …”

Here’s what the old policy said:

“(1) encourage recognition that federal efforts at supply reduction and enforcement should be accompanied by increased efforts to reduce the demand for illicit drugs; (2) renew and expand federal leadership to reduce the demand for illicit drugs …”

Looks like the AMA sees the harm to people from incarceration is worth working into the nation’s equation for how to tackle marijuana.

The fumble

The next change is simply a reaction to the fact that voters in Washington and Colorado got ahead of the federal government and this body of doctors:

What the edited version says:

(5) encourages a comprehensive review of the risks and benefits of U.S. state-based drug legalization initiatives and, that, until the findings of such reviews can be adequately assessed, the AMA reaffirm its opposition to drug legalization

What it used to say:

(5) encourages the undertaking of comprehensive research into the potential effects, both positive and adverse, of relaxing existing drug prohibitions and controls and, that, until the findings of such research can be adequately assessed, the AMA reaffirm its opposition to drug legalization

“Other testimony supported the view that the Council had not gone far enough, and that policy should at least be neutral on the issue of cannabis legalization given the shifts in state-based policies and public attitudes. Additionally, the term “criminal penalties” was offered as a substitute for “incarceration” in Recommendation 4, a change supportive of decriminalization.”

The Punt

In the wrap-up of testimony, this sentence captures the essence of The Punt:

“Support was offered for the philosophical position that addressing illicit drug use, especially for cannabis, is best achieved by employing a public-health based approach that reduces individual harm from drug use while preserving the state’s interest in protecting the public from the adverse consequences of individual drug use.”

In other words, jailing people isn’t working but marijuana shouldn’t be legalized or decriminalized.

But can the nation have it both ways? It seems clear that marijuana cannot be properly researched – like the AMA and everyone else wants – unless the federal stance toward marijuana changes or significantly de-escalates.

This is pretty much the same “punt” that has been promoted by Gil Kerlikowske, director of the White House Office of National Drug Control Policy:

“While the prosecution of drug traffickers remains an important priority, targeting individual marijuana users is not the best allocation of federal law enforcement resources. … Expanding programs like drug courts that divert nonviolent offenders into treatment instead of prison is one example,” he said in an interview with the Washington Post.

Middle ground or DMZ?

So, the AMA delegates seem to be saying they don’t have the political courage … er … evidence to back decriminalization or reducing the status of marijuana from Schedule 1, where it sits among the worst drugs.

That said, the group is legitimately worried about the fact that marijuana is not harmless.

Somewhat lost in the debate about legalization of cannabis are the recognized harms. Cannabis continues to be the most commonly used illicit drug in the U.S. with patterns of use trending upward, particularly among youth. A substantial number of individuals in the U.S. meet criteria for substance dependence or abuse, with only a minority able to access treatment. Treatment admissions for cannabis as the primary drug of abuse have tripled over the last 20 years. It is the most common illicit drug involved in drugged driving, particularly in drivers under the age of 21. Early cannabis use is related to later substance use disorders. Heavy cannabis use in adolescence causes persistent impairments in neurocognitive performance and IQ, and use is associated with increased rates of anxiety, mood, and psychotic thought disorders.

Nevertheless, this hedging and, essentially, punting of the difficult choice to legalize or at least decriminalize marijuana and deal with it socially (like alcohol and cigarettes) looks like fear of the unknown, instead of science and true concern for the individual.